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1 Mark Adickes, M.D. Orthopedics and Sports Medicine 7200 Cambridge St. #10A Houston, Texas Phone: Fax: DISTAL BICEPS TENDON REPAIR PROTOCOL This rehabilitation protocol has been developed for the patient following a tenodesis (reattachment) of the long head of the biceps tendon surgery. This protocol will vary in length and aggressiveness depending on factors such as: Quality of the repaired biceps tendon tissue Presence of additional procedures such as shoulder arthroscopy Degree of shoulder instability or weakness or deconditioning prior to surgery Acute versus chronic condition Length of time immobilized Strength/pain/swelling/range of motion status Rehabilitation goals and expectations Early passive range of motion is highly beneficial to enhance circulation within the joint to promote healing. The protocol is divided into phases. Each phase is adaptable based on the individual and special circumstances. The overall goals of the surgical procedure and rehabilitation are to: Control pain, inflammation, and swelling Regain normal upper extremity strength and endurance Regain normal shoulder range of motion Achieve the level of function based on the orthopedic and patient goals Physical therapy should be initiated after the first week post-op. The supervised rehabilitation program is to be supplemented by a home fitness program where the patient performs the given exercises at home or at a gym facility. Important post-op signs to monitor: Swelling of the arm or shoulder and surrounding soft tissue Abnormal pain response, hypersensitivity, increasing night pain Severe range of motion limitations Weakness in the upper extremity musculature Improper mechanics or scapular dyskinesia Core and peri-scapular strength deficits Return to activity requires both time and clinical evaluation. To safely and most efficiently return to normal or high level functional activity, the patient requires adequate strength, flexibility, and endurance. Functional evaluation including strength and range of motion testing is one method of evaluating a patient s readiness return to activity. Return to intense activities following a biceps tenodesis requires both a period of time to

2 allow for tissue healing along with a graduated strengthening and range of motion program. Symptoms such as pain or swelling should be closely monitored by the patient and therapist. Specific exercises may be added, substituted, or modified where clinically appropriate by experienced sports/shoulder therapists or trainers who have expertise in the care of post-operative tendon repair procedures. While patients may be "cleared" to resume full activities at 6+ months following surgery, additional time spent in full activity or sport participation is often necessary to achieve maximal recovery.

3 DISTAL BICEPS REPAIR PHASE 1: WEEK 1-2 PRECAUTIONS Post splint at 90 elbow flexion is to be worn for 1 st 2 weeks in neutral forearm position No active supination for 14 days No active elbow flexion 6 weeks Gradual Active/Passive of shoulder in all planes while in splint Wrist/hand/finger full A in splint STRENGTH Scapular retractions Shoulder shrugs Hot pack before treatment E-stim, TENS as needed Ice minutes after treatment GOALS OF PHASE 1 Control pain and inflammation Protect repair Independent in HEP PHASE 2: WEEK 3-6 PRECAUTIONS Elbow placed in a hinged brace set unlocked at 45 to full flexion. Brace to be worn at all times except during exercise or bathing Passive for elbow flexion Assisted for elbow extension and supination/pronation (with elbow at 90 ) Shoulder A as needed based on evaluation, avoiding excessive extension Hinged Brace Range of Motion Progression ( progression may be adjusted base on Surgeon s assessment of the surgical repair.) o Week 2 45 to full passive elbow flexion o Week 3 45 to full passive elbow flexion o Week 4 30 to full passive elbow flexion o Week 5 20 to full passive elbow flexion o Week 6 10 to full passive elbow flexion Forearm: Initiate AA pronation and supination Progress to active pronation and supination (wk 4)

ROTATOR CUFF REPAIR PROTOCOL This rehabilitation protocol has been developed for the patient following a rotator cuff surgical procedure. This protocol is based on slower progressions, typically for larger

Rotator Cuff Repair Rehabilitation Protocol Dr. Mark Adickes Introduction: This rehabilitation protocol has been developed for the patient following a rotator cuff repair. This protocol will vary in length

SLAP Lesion Repair Rehabilitation Protocol Dr. Mark Adickes Introduction: This rehabilitation protocol has been developed for the patient following a SLAP (Superior Labrum Anterior Posterior) repair. It

Anterior Shoulder Instability Surgical Repair Protocol Dr. Mark Adickes Introduction: This rehabilitation protocol has been developed for the patient following an arthroscopic anterior stabilization procedure.

SLAP Repair Protocol Anatomy and Biomechanics The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus (ball) and the glenoid portion of the scapula

Department of Rehabilitation Services Physical Therapy The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone

Combined SLAP with Arthroscopic Rotator Cuff Repair Large to Massive Tears = or > 3 cm *It is the treating therapist s responsibility along with the referring physician s guidance to determine the actual

Rotator Cuff Repair Protocol Anatomy and Biomechanics The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus (ball) and the glenoid portion of

Arthroscopic Rotator Cuff Repair Postoperative Rehab Protocol Starting the first day after surgery you should remove the sling 3-4 times per day to perform pendulum exercises and elbow/wrist range of motion

Johns Hopkins Shoulder Surgery Rotator Cuff Rehabilitation Program Johns Hopkins Shoulder Surgeons INTRODUCTION: This program is designed for rotator cuff repairs involving fixation of the tendon to bone,

REHABILITATION GUIDELINES FOR SUBSCAPULARIS (+/- SUBACROMINAL DECOMPRESSION) The rehabilitation guidelines are presented in a criterion based progression. General time frames are given for reference to

: The intent of this protocol is to provide the therapist with a guideline for the postoperative rehabilitation course of a patient that has undergone a Total Shoulder Arthroplasty (TSA) or Hemiarthroplasty

Department of Rehabilitation Services Physical Therapy This protocol has been adopted from Brotzman & Wilk, which has been published in Brotzman SB, Wilk KE, Clinical Orthopeadic Rehabilitation. Philadelphia,

SLAP Repair Protocol Arthroscopic Labral Repair Protocols (Type II, IV and Complex Tears) This protocol has been modified and is being used with permission from the BWH Sports and Shoulder Service. The

Department of Rehabilitation Services Physical Therapy The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone

Pectoralis Major Muscle Rupture The pectoralis major muscle is the large muscle in front of the upper chest. There are two parts of the pectoralis muscle, the pectoralis major and the pectoralis minor.

Post-Op to Week 3: Distal Biceps Re-Insertion Rehabilitation Protocol - Pt is immobilized in 90 degrees of flexion, neutral rotation and wrist in a position of comfort, either a cast or brace/splint may

POST SURGICAL INSTRUCTIONS When coming for your post op visit, please bring this folder that includes your surgical pictures. The doctor would like to go over them with you during your post op appointment.

Anterior Cruciate Ligament Reconstruction Accelerated Rehab This rehabilitation protocol has been designed for patients with ACL reconstruction who anticipate returning to a high level of activity as quickly

Make sure you check with the surgeon before you start using any protocol. Also, obtain a copy of the post-operative report from the surgeon Knee Arthroscopy Physical Therapy Protocol This rehabilitation

Meniscus Repair Rehabilitation Protocol Dr. Mark Adickes Introduction: This rehabilitation protocol was developed for patients who have isolated meniscal repairs. Depending upon the complexity of the tear

1 Elbow Dislocation Rehabilitation Protocol Elbow Dislocation The Elbow Joint is the most complex joint in the body. In order for it to recover to its best function consistent rehabilitation is essential

Meniscus Repair Rehabilitation Dr. Walter R. Lowe This rehabilitation protocol was developed for patients who have isolated meniscal repairs. Meniscal repairs located in the vascular zones of the periphery

Tel: 617 ANATOMY AND FUNCTION SHOULDER - TORN ROTATOR CUFF The shoulder joint is a ball and socket joint that connects the bone of the upper arm (humerus) with the shoulder blade (scapula). The capsule

Rotator Cuff Impingement/Tendinopathy Anatomy and Biomechanics The shoulder is a wonderfully complex joint that is made up of the ball and socket connection between the humerus (ball) and the glenoid portion

UW Health Sports Rehabilitation Rehabilitation Guidelines for Biceps Tenodesis The shoulder has two primary joints. One part of the shoulder blade, called the glenoid fossa forms a flat, shallow surface.

POSTERIOR CAPSULAR SHIFT REHABILITATION PROTOCOL The goal of this rehabilitation program is to return the patient/athlete to their activity/sport as quickly and safely as possible while maintaining a stable

Rehabilitation Guidelines for Posterior Shoulder Reconstruction with or without Labral Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a

The rehabilitation protocol has been designed for patients with ACL reconstruction who anticipate returning early to a high level of activity postoperatively. The ACL Rehabilitation protocol for all three

UHealth Sports Medicine REHABILITATION GUIDELINES FOR POSTERIOR SHOULDER RECONSTRUCTION +/- LABRAL REPAIR The rehabilitation guidelines are presented in a criterion based progression. General time frames

Rehab Protocol This rehabilitation protocol has been designed for patients who have undergone an MPFL reconstruction. Dependent upon the particular procedure, this protocol also may be slightly deviated

Rehabilitation Guidelines For SLAP Lesion Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee. This is because the articular surface of

Anterior Cruciate Ligament Reconstruction Accelerated Rehabilitation Protocol Introduction: This rehabilitation protocol is designed for patients with ACL injuries who anticipate returning early to a high

Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on

Rehabilitation Guidelines For SLAP Lesion Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee. This is because the articular surface of

General Principles: This protocol was designed to exercise the major muscles necessary for throwing. All exercises included are specific to the throwing athlete and are designed to improve strength, power,

Post Operative Total Hip Replacement Protocol Brian J. White, MD www.western-ortho.com The intent of this protocol is to provide guidelines for progression of rehabilitation. It is not intended to serve

SHOULDER INSTABILITY - DISLOCATION AND SUBLUXATION THE INJURY The shoulder joint is a ball and socket joint that connects the bone of the upper arm (humerus) with the shoulder blade (scapula). The shallow

: General Information: Reverse or Inverse Total Shoulder Arthroplasty (rtsa) is designed specifically for the treatment of glenohumeral (GH) arthritis when it is associated with irreparable rotator cuff

Anterior Cruciate Ligament Reconstruction Rehab Protocol This rehabilitation protocol has been designed for patients following ACL reconstruction who anticipate returning to a high level of activity as

REHABILITATION DEPARTMENT Cervical Fusion Protocol The following protocol for physical therapy rehabilitation was designed based on the typical patient seen at the Texas Back Institute for the procedure

617-726-7500 www2.massgeneral.org/sports Clavicle Fracture (Broken Collarbone) A broken collarbone is also known as a clavicle fracture. This is a very common fracture that occurs in people of all ages.

UHealth Sports Medicine Rehabilitation Guidelines for Meniscal Repair The rehabilitation guidelines are presented in a criterion based progression. Specific time frames, restrictions and precautions are

Arthroscopic Repair of Superior Labral Anterior-Posterior (SLAP) Injuries- Dr. Trueblood Indications: Pain and disability of the shoulder secondary to the detachment of the long head of the biceps origin

ANATOMY AND FUNCTION SHOULDER - TORN ROTATOR CUFF The shoulder joint is a ball and socket joint that connects the bone of the upper arm (humerus) with the shoulder blade (scapula). The capsule is a broad